Conversion factors for laparoscopic splenectomy for immune thrombocytopenic purpura

Brody, Fred; Chekan, Edward; Pappas, Theodore N.; Eubanks, William S.

doi:10.1007/s004649901100

Cited by 29 publications

(42 citation statements)

References 6 publications

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“…In a report by Brody et al [18], the platelet count was identified as an important predictor of conversion, and the suggested cutoff point was 35 Â 10 9 /L. Since then, however, several other authors have shown that laparoscopic completion is feasible [3,18]. In our series, the platelet count did not affect the conversion rate, but because the group of patients with a low platelet count is small, in no way it excludes the possibility that the platelet count may play a role as a conversion factor.…”

Section: Discussionmentioning

confidence: 96%

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Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count

2005

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Laparoscopic splenectomy (LS) is now performed routinely in patients with idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment. Low preoperative platelet count was deemed to be a contraindication for a laparoscopic approach; however, there is no data reporting the outcome in those patients. We aimed to evaluate the influence of the preoperative platelet count on the operative and postoperative course and complication rate. Retrospective cohort study that was conducted in tertiary care university-affiliated medical center and included 110 consecutive patients who underwent LS. All patients were divided into three groups by their preoperative platelet counts: £20 · 10 9 /L (n = 12), (20-50) · 10 9 /L (n = 18), and >50 · 10 9 /L (n = 80). The outcome and the influence of preoperative factors predictive of complications, blood transfusion, and length of stay were compared between the groups. Patients with a platelet count of £20 · 10 9 /L had a much longer hospital stay, received more blood transfusions, and suffered more complications than patients with platelet counts of (20-50) · 10 9 /L or higher (P < 0.05). Transfused patients had a longer hospital stay than non-transfused patients (2.08 vs. 6.4 days, P = 0.029). The strongest predictor for transfusion was the platelet count (odds ratio = 23, P = 0.008). LS in patients with very low platelet counts is feasible and reasonably safe, but the platelet count is a major determinant of morbidity. Every effort should be made to elevate platelet levels to >20 · 10 9 /L before surgery. Patients with counts >20 · 10 9 /L can safely undergo LS. Am. J. Hematol. 80:95-100, 2005. ª 2005 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count

2005

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“…This phenomenon is Table VI. Treatment of complications requiring surgical intervention often described in the literature [5,9,10,11,14,15]. More importantly, complication-driven conversions were reduced significantly, from 0.6% in the 1 st period to 0.27% and 0.26%.…”

Section: Discussionmentioning

confidence: 96%

“…In the next stage, the number of procedures performed laparoscopically increases significantly and the spectrum of indications broadens. Year after year, the rate of technically advanced procedures, such as Nissen fundoplication, cardiomyotomy, splenectomy and adrenalectomy, increases [8][9][10][11]. In spite of proven experience, the complexity of new procedures and freer qualification of patients prevent the total number of adverse events from falling substantially [8,10].…”

Section: Discussionmentioning

confidence: 99%

Analysis of complications of laparoscopic management of abdominal diseases related to extended indications

Rembiasz¹,

Bobrzyński²,

Budzyński³

et al. 2010

Videosurgery and Other Miniinvasive Techniques

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“…What is more, the size of the operated organ (both adrenal gland tumour and spleen) did not seem to considerably infl uence the means of fi nishing the operation. Connection between the conversion and the adrenal gland tumour (especially the pheochromocytoma type) during adrenalectomy, or the level of platelets in patients undergoing splenectomy was not observed (4,18,19,20).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Conversion Rates and Reasons in Minimally Invasive Surgery

Strzałka¹,

Budzyński²,

Bobrzyński³

et al. 2009

Polish Journal of Surgery

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Nowadays the number and range of laparoscopic procedures is quickly increasing and contraindications are limited. But laparoscopic operations cannot be performed in every case, what leads to conversion. The aim of the study was to present the conversion rates and reasons in different types of laparoscopic procedures, both emergency and elective. Material and methods. 7685 patients operated laparoscopically in the 2 nd Department of General Surgery of the Jagiellonian University between 1993 and 2008 were included in the study. Minimally invasive approach was used at the beginning in 608 patients with acute appendicitis (average age = 28,4 years), in 101 patients with perforated peptic ulcer (average age = 46.4 years), in 236 patients who underwent splenectomy (average age = 41 years), in 166 patients who had adrenalectomy (average age = 53 years), in 117 patients who underwent Nissen fundoplication (average age = 44,4 years), in 834 individuals who had inguinal hernia repair (average age = 49.4years), in 5311 who had cholecystectomy (average age = 52.1 years and in 212 patients who underwent other procedures. Results. The conversion rates in the analyzed period were 2.88% in whole material, in case of appendectomy 3,95%, perforated ulcer operation 19,80%, splenectomy 2.12%, adrenalectomy 1.81%, Nissen fundoplication 1.71%, inguinal hernia repair 0.96% and cholecystectomy 2.92%. Emergency surgery was related to higher (4.98%) conversion rate than elective procedures (1.88%). Most frequently convestions were related to technical reasons (2,48%), than enforced by complications (0.41%). Conclusion. Most conversions were caused by technical reasons, not complications. The change of the approach from laparoscopic to open one was more frequent in case of emergency procedures.

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Conversion factors for laparoscopic splenectomy for immune thrombocytopenic purpura

Cited by 29 publications

References 6 publications

Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count

Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count

Analysis of complications of laparoscopic management of abdominal diseases related to extended indications

Analysis of Conversion Rates and Reasons in Minimally Invasive Surgery

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